410 Statement of Organization Recipient Committee - Amendment 03-04-19 Stamped by SOS"H " r gi
;Recipient Commits
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ON
CUPERTINO CITY
I] Amendment ❑ Termination — See Part 5
jyetqlified
ed as committee
Date qualified as committee Date of termination
1. Committee Information I.D. Number
(if applicable) 1299673
NAME OF COMMITTEE
CUPERTINO CHAMBER OF COMMERCE PAC
STREETADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
MAILING ADDRESS (IF DIFFERENT)
E-MAILADDRESS (REQUIRED) / FAX (OPTIONAL)
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE
SANTA CLARA I CITY OF CUPERTINO
Attach additional information on appropriately labeled continuation sheets.
Date Stamp
WEI6 EBF AND FII E W FbYoffici4 tt3 Only -I
the oM.M of the Stcretiiry of 84 to FEB 11 2019
of the State of 05111'erAIN
JAN 3 0 2019 R =T" A n 01 V0T4 3
06U -`43'f OF SANTA CLARA
2. Treasurer and Other Principal Officers
NAME OF TREASURER
RICHARD ABDALAH
STREET ADDRESS (NO P.O. BOX)
CITY
STATE
ZIP CODE
AREA CODE/PHONE
NAME OF ASSISTANT TREASURER, IF ANY
SAMUEL HARVEY
STREET ADDRESS (NO P.O. BOX)
CITY
STATE
ZIP CODE
AREA CODE/PHONE
NAME OF PRINCIPAL OFFICER(S)
KEVIN MCCLELLAND
STREET ADDRESS (NO P.O. BOX)
CITY
STATE
ZIP CODE
AREA CODE/PHONE
3. Verification
I have used all reasonable diligence in. preparing this statement
Executed on
DATE
Executed on
DATE
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410(February/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee•
INSTRUCTIONS ON REVERSE
,
OR10
.-
Page 2 0£ 4
COMMITTEE NAME
I.D. NUMBER
CUPERTINO CHAMBER OF COMMERCE PAC
1299673
2a. Additional Officers / Assistant Treasurers
NAME
NAME
RICHARD ABDALAH
MAILING ADDRESS
MAILING
ADDRESS
CITY
STATE
ZIP CODE
AREA CODE/PHONE
CITY
STATE
ZIP CODE AREA CODE/PHONE
NAME
NAME
MAILING ADDRESS
MAILING
ADDRESS
CITY
STATE
ZIP CODE
AREACODE/PHONE
CITY
STATE
ZIPCODE AREA CODE/PHONE
NAME
NAME
MAILING ADDRESS
MAILING
ADDRESS
CITY
STATE
ZIP CODE
AREA CODE/PHONE
CITY
STATE
ZIP CODE AREA CODE/PHONE
NAME
NAME
MAILING ADDRESS
MAILING
ADDRESS
CITY
STATE
ZIP CODE
AREA CODE/PHONE
CITY
STATE
ZIP CODE AREACODE/PHONE
www.netfile.com FPPC Form 410 (February/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Paget Page 3 of 4
COMMITTEE NAME I.D. NUMBER
CUPERTINO CHAMBER OF COMMERCE PAC 1299673
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
BANK OF THE WEST (
ADDRESS CITY STATE ZIP CODE
4. Type of Committee Complete the applicable sections.
Controlled Committee
• List the name of each controlling officeholder, candidate, or state measure proponent. If candidate or officeholder controlled, also list the elective office sought or held, and
district number, if any, and the year of the election.
• List the political party with which each officeholder or candidate is affiliated or check "nonpartisan." Stating "No party preference" is acceptable.
• If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee.
ELECTIVE OFFICE SOUGHT OR HELD YEAR OF PARTY
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION rw—nnic
Primarily Formed Committee , Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATES) NAME OR MEASURE(S) FULLTITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECKONE
FPPC Form 410 (February/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Page Page 4 of 4
ITTEE NAME
I.D. NUMBER
CUPERTINO CHAMBER OF COMMERCE PAC I 1299673
4. Type of Committee (Continued)
Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
0 CITY Committee ❑ COUNTY Committee ❑ STATE Committee ❑ Political Party/Central Committee
TO SUPPORT LOCAL AND STATEWIDE CANDIDATES AND BALLOT MEASURES
List additional sponsors on an attachment.
NAME OF SPONSOR
CUPERTINO CHAMBER OF COMMERCE
INDUSTRY GROUP OR AFFILIATION OF SPONSOR
]IKttl AUUKL]b NO. AND STREET CITY STATE ZIP CODE AREA CODE/PHONE
Small Contributor Committee 'i ❑
Date qualified
5. Termination Requirements By signing the verification, the treasurer, assistant treasurer and/or candidate, officeholder, or proponent certify that all of the following conditions have been met:
• This committee has ceased to receive contributions and make expenditures;
• This committee does not anticipate receiving contributions or making expenditures in the future;
• This committee has eliminated or has no intention or ability to discharge all debts, loans received, and other obligations;
• This committee has no surplus funds; and
• This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions.
-- There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to Government
Code Section 89519.
-- Leftover funds of ballot measure committees may be used for political, legislative or governmental purposes under Government Code Sections 89511 - 89518, and are
subject to Elections Code Section 18680 and FPPC Regulation 18521.5.
FPPC Form 410 (February/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov